IFAMM Change of Name Form
In order to change the name we have on file, we must have a signed statement from you requesting the change. We value your membership and thank you for uniting with us.
I, type your name:
*
First Name
Last Name
from the State of
*
a member of Lodge/Chapter Name:
*
and my Roll # is:
*
wish to CHANGE my name to:
*
First Name
Last Name
E-mail
*
example@example.com
Home Number
Format: (000) 000-0000.
Cellular Number
Format: (000) 000-0000.
I am a signer on the following IM Detroit Credit Union Account(s):
I am a signer on the following IM Detroit Credit Union Account(s):
I am a signer on the following IM Detroit Credit Union Account(s):
I am a signer on the following IM Detroit Credit Union Account(s):
Member Signature:
Today's Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Change of Name Form
Should be Empty: